Concepts of Mental Health Notes

Historical Overview of Mental Health Care

  • Early history: Physically or mentally ill individuals were believed to be possessed by evil spirits.
  • Early Christians: Mental illness was viewed as punishment for sins, demonic possession, or witchcraft.
  • 17th and 18th centuries: Conditions for the mentally ill worsened.
  • 20th century: Mental health care reform began.
  • Omnibus Budget Reconciliation Act of 1981: Significant legislation impacting mental health services.

Mental Health Continuum

  • Mental health and mental illness exist on opposite ends of a continuum.
  • Assessment involves evaluating components of mental health.
  • Mental illness is determined by observed behavior and the context in which it occurs.
  • Often results from an inability to cope with overwhelming situations.

Basic Concepts of Mental Health

  • Mental health: The ability to cope with and adjust to everyday stresses.
  • Mental illness: Characterized by conspicuous, threatening, and disruptive behaviors that deviate from acceptable norms.
  • Essential to maintain a caring, trusting relationship when assessing and intervening.
  • Goal: To help individuals develop satisfying and productive coping mechanisms for daily living.

Personality and Self-Concept

  • Personality
    • Understanding personality through the theories of:
    • Erik Erikson
    • Sigmund Freud
  • Self-concept: An individual's frame of reference for all experiences.
    • Encompasses perceptions, values, behaviors, and interactions.

Erickson and Freud Stages of Psychosocial Development

  • Erik Erikson's Stages of Psychosocial Development:

    • Infant: Trust vs. Mistrust
    • Toddler: Autonomy vs. Shame & Doubt
    • Pre-schooler: Initiative vs. Guilt
    • Grade-schooler: Industry vs. Inferiority
    • Teenager: Identity vs. Role Confusion
    • Young Adult: Intimacy vs. Isolation
    • Middle-age Adult: Generativity vs. Stagnation
    • Older Adult: Integrity vs. Despair

  • Levels of Awareness (Freud):

    • Conscious Level
    • Preconscious Level
    • Unconscious Level

  • Components of Personality (Freud):

    • Id: Basic impulses (sex and aggression), seeking immediate gratification; operates at an unconscious level; irrational and impulsive.
    • Ego: Executive mediating between id impulses and superego inhibitions; testing reality; rational; operates mainly at the conscious level but also at the preconscious level.
    • Superego: Ideals and morals; striving for perfection; incorporated from parents; becoming a person's conscience; operates mostly at the preconscious level.

Defense Mechanisms

  • Repression: Unconsciously keeping disturbing thoughts from becoming conscious.
    • Example: Repressing aggressive thoughts about same-sex parents during the Oedipus complex.
  • Denial: Blocking external events from awareness; refusing to experience overwhelming situations.
    • Example: Smokers refusing to admit smoking is bad for their health.
  • Projection: Attributing unacceptable thoughts, feelings, and motives to another person.
    • Example: Believing someone hates you because your superego deems your hatred for them unacceptable.
  • Displacement: Satisfying an impulse with a substitute object.
    • Example: Kicking the dog after being frustrated by the boss.
  • Regression: Moving back to an earlier psychological time when faced with stress.
    • Example: A child sucking their thumb again when hospitalized.
  • Sublimation: Satisfying an impulse in a socially acceptable way.
    • Example: Channeling aggression into sports.

Stress

  • Stressors: Physical, social, chemical, spiritual, or developmental factors, or a combination of these.
  • Individual responses to stressful situations are often learned or conditioned behaviors.
  • Stress is a nonspecific response of the body to any demand made on it.

Stress Response & Symptoms

  • Physical Symptoms of Stress

    • Increased heart rate
    • Difficulty breathing
    • Tremors and feeling dizzy
    • Fatigue and exhaustion
    • Digestive problems
    • Body aches and pains

  • Emotional Symptoms of Stress

    • Irritability and anger
    • Anxious, restless, or nervous
    • Loneliness or lack of purpose
    • Unhappiness and a lack of motivation
    • Crying more often than normal

  • Behavioral Symptoms of Stress

    • Using alcohol or drugs to cope
    • Avoiding family or friends
    • Changes in diet, such as overeating
    • Sleeping too much or too little
    • Criticizing others
    • Difficulty concentrating

Factors Contributing to Mental Illness

  • Anxiety
  • Motivation
  • Frustration
  • Conflict

Illness Behaviors

  • Illness
  • Crisis
  • Illness behaviors
  • Denial
  • Anxiety
  • Shock
  • Anger
  • Withdrawal

Adaptation and Coping

  • Adaptation
  • Coping responses: Used to reduce anxiety brought on by stress.
    • May be used consciously or unconsciously.
    • Defense mechanisms.

Crisis Intervention

  • Crises can be triggered by serious illness, relationship breakups, accidents, or the death of a loved one.
  • Phases of crisis are similar to stages of grief:
    • Confusion, disbelief, and high anxiety.
    • Denial.
    • Reality; anger and remorse.
    • Sadness and crying.
    • Reconciliation and adaptation.

6-Step Crisis Intervention Model

  1. Define the Problem: Use active listening, empathy, genuineness, and understanding.
  2. Ensure the Individual's Safety: Conduct suicide and homicide risk assessments; control access to dangerous items.
  3. Provide Support: Offer emotional, instrumental, and informational support.
  4. Explore Alternatives: Help explore new solutions, coping skills, situational supports, and additional assistance.
  5. Make Plans: Build a realistic, achievable plan with clear steps to regain control.
  6. Obtain Commitment: Ask the client to verbalize or write down the plan to confirm understanding.

Nursing Assessment

  • Observe patient behavior.
  • Assist in establishing patient problem statements.
  • Work with the registered nurse (RN) on outlining appropriate nursing interventions.